Is there a difference between carbon dioxide and argon gas embolisms in laparoscopic liver resection?

• Background:Several methods are available to control bleeding during laparoscopic liver resection (LLR).  One of these techniques, argon enhanced coagulation (AEC), could be hazardous because of the argon gas.  Argon gas has poorer solubility in blood than CO2.  Previous animal studies have shown the danger of gas embolism during LLR.  The aim of this study was to compare the effects of Argon gas embolism and CO2 embolism, with special emphasis on pulmonary circulation and gas exchange, during laparoscopic liver surgery.Method:Sixteen piglets underwent laparoscopic left lateral liver resection and were randomised to either CO2 or argon pneumoperitoneum, at 16 mmHg.  The pulmonary circulation of the animals was monitored with a pulmonary arterial catheter.  Paratrend® was used to continuously measure PaCO2, PaO2, and pH, and transoesophageal ultrasound was used to detect embolisms on the right side of the heart.Results: Equal amount of embolism were seen in both groups.  The mean pulmonary arterial pressure (MPAP) increased in the Argon-group (P=0.050) as did the pulmonary vascular resistance (PVR) (P=0.015) compared with the CO2-group, correlating with the amount of embolism.  The gas exchange was then affected with an decrease in PaO2 and increase in PaCO2 , resulting  in acidosis.Conclusion:Argon gas embolism has more effects on pulmonary circulation and gas exchange than CO2.  If used, great care should be taken with argon gas and the patient should be carefully monitored during LLR.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

Nyckelord

gas embolism

laparoscopy

liver surgery

pneumoperitoneum

argon.

Publikations- och innehållstyp

vet (ämneskategori)

ovr (ämneskategori)